title: Salvaging the pullout strength of stripped screws in osteoporotic bone.
abstract: Our goal was to determine whether the pullout strength of stripped screw holes in osteoporotic bone could be increased with readily available materials from the operating room. We inserted 3.5-mm stainless steel nonlocking self-tapping cortical screws bicortically into 5 osteoporotic humeri. Each screw was first stripped by rotating it 1 full turn past maximum torque. In the control group, the screw was pulled out using an MTS machine (858; MTS Inc, Eden Prairie, Minnesota). In the treatment groups, the screw was removed, the hole was augmented with 1 of the 3 materials (stainless steel wire, polysorb suture, or polyethylene terephthalate glycol plastic sheet), and the screws were replaced and then pulled out. The effect of material on pullout strength was checked for significance (P < .05) using a general linearized latent and mixed model (Stata10; StataCorp, College Station, Texas). The mean (95% confidence interval) pullout strength for the unaugmented hole was 138 N (range 88-189), whereas the holes augmented with plastic, suture, or wire had mean pullout strengths of 255 N (range 177-333), 228 N (range 149-308), and 396 N (range 244-548), respectively. Although wire augmentation resulted in pullout strength that was significantly greater than that of the unaugmented screw, it was still below that of the intact construct.
authors.affiliation: Department of Orthopaedic Surgery, International Center for Orthopaedic Advancement, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
authors.forename: Pierre H M
authors.initials: PH
authors.lastname: Pechon
authors.forename: Simon C
authors.initials: SC
authors.lastname: Mears
authors.forename: Evan R
authors.initials: ER
authors.lastname: Langdale
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Belkoff
keywords: ankle fracture; bone density; humerus fracture; inadvertent stripping; osteoporosis; screw stripping